The trouble is not to model how Ebola might spread, but the 'political' reaction in an area with so many armed rebel groups. The situation is too complex for me to make a meaningful guess, but this in itself indicates a bleaker outlook.

Given the location of the outbreak it could spread to other countries, and due to mobility (of health workers) one or two cased may occur in another WHO Health region, but these would be easier to contain so I don't think it likely to become a pandemic.

BTW. My crystal ball does not work well. Given the past record of the Congo handling Ebola, at first I thought this outbreak would be brought quick under control. But I will make a guess anyway for a regional scale outbreak.

Centers for Disease Control and Prevention Director Robert Redfield said Monday that the Ebola outbreak in conflict-ridden Congo has become so serious that international public health experts need to consider the possibility that it cannot be brought under control and instead will become entrenched.

If that happened, it would be the first time since the deadly viral disease was first identified in 1976 that an Ebola outbreak led to the persistent presence of the disease. In all previous outbreaks, most of which took place in remote areas, the disease was contained before it spread widely. The current outbreak is entering its fourth month, with nearly 300 cases, including 186 deaths.

If Ebola becomes endemic in substantial areas of North Kivu province, in northeastern Congo, “this will mean that we’ve lost the ability to trace contacts, stop transmission chains and contain the outbreak,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security, which hosted the briefing on Capitol Hill that featured the Ebola discussion with Redfield.

In that scenario, there would be a sustained and unpredictable spread of the deadly virus, with major implications for travel and trade, he said, noting that there are 6 million people in North Kivu. By comparison, the entire population of Liberia, one of the hardest-hit countries during the West Africa Ebola epidemic of 2014-2016, is about 4.8 million.

The outbreak is taking place in a part of Congo that is an active war zone. Dozens of armed militias operate in the area, attacking government outposts and civilians, complicating the work of Ebola response teams and putting their security at risk. Violence has escalated in recent weeks, severely hampering the response. The daily rate of new Ebola cases more than doubled in early October. In addition, there is community resistance and deep mistrust of the government.

Some sick people have refused to go to treatment centers, health-care workers are still being infected, and some people are dying of Ebola or spreading the virus to new areas. An estimated 60 to 80 percent of new confirmed cases have no known epidemiological link to prior cases, making it very difficult for responders to track cases and stop transmission. In late August, the United States withdrew some of the CDC’s most seasoned Ebola experts who had been stationed in Beni, the province’s urban epicenter, because of security risks.

“I do think this is one of the challenges we’ll have to see, whether we’re able to contain, control and end the current outbreak with the current security situation, or do we move into the idea that this becomes more of an endemic Ebola outbreak in this region, which we’ve never really confronted,” Redfield said.

If that happens, health-care responders may need to consider vaccinating broader populations instead of the current strategy of vaccinating those who have been in contact with infected people.

When contact tracing begins to fall apart, “then you are entering another phase and losing the hope that you can arrest the outbreak through standard interventions,” J. Stephen Morrison, senior vice president at the Center for Strategic and International Studies, said in an interview. In a new report, Morrison wrote that there is an urgent need for “high-level political attention focused on generating an updated game plan” to improve security, train and deploy community health workers, and win community trust.

“This is going to be a complicated and deeply problematic situation and we need to prepare ourselves for dealing with this long term,” Morrison said.

Redfield, officials from the World Health Organization and other experts say one of the biggest worries is the spread within Congo to places like Butembo, a major trading port and urban area, where the risk of widespread transmission escalates dramatically.

In mid-October, the World Health Organization said that it was “deeply concerned” by the outbreak but that the situation did not yet warrant being declared a global emergency. The U.N. health agency called for response activities to be “intensified.” The WHO’s director general, Tedros Adhanom Ghebreyesus, and a top U.N. official for peacekeeping operations, are in Congo this week to take stock of the response.

-spread by aidworkers, "crisis-hopping" care givers moving from one region to the other, transporting the ebola-virus to places like Somalia, Yemen, Bangla Desh. There are an increasing number of "good feeding grounds" for the Ebola-virus. The incubation period can be 2 to 21 days, if the virus could show up later the virus could start spreading later. https://www.who.int/csr/disease/ebola/faq-ebola/en/

Just like climate change health issues should be an international top-priority and is not. The international community is not doing enough to get the situation under control. So in my opinion ebola is winning-humanity is losing.

We cannot solve our problems with the same thinking we used when we created them.~Albert Einstein

As the Ebola outbreak in the Democratic Republic of the Congo (DRC) approaches 1 000 cases amid increased violence, WHO reaffirmed its commitment both to ending the outbreak and working with the government and communities to build resilient health systems.

Since the outbreak was declared in August 2018 there have been 993 confirmed and probable cases and 621 deaths in North Kivu and Ituri provinces.

“We use words like ‘cases’ and ‘containment’ to be scientific, but behind every number is a person, a family and a community that is suffering,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“This outbreak has gone on far too long. We owe it to the people of North Kivu to work with them in solidarity not only to end this outbreak as soon as possible, but to build the health systems that address the many other health threats they face on a daily basis.”

More than 96 000 people have been vaccinated against Ebola in DRC, along with health workers in Uganda and South Sudan. As of 21 March, 38 of 130 affected health areas have active transmission. More than 44 million border screenings have helped to slow the spread of Ebola in this highly mobile population. No cases have spread beyond North Kivu and Ituri provinces, and no cases have crossed international borders.

However, the risk of national and regional spread remains very high, especially when episodes of violence and instability impact the response.

“As we mourn the lives lost, we must also recognize that thousands of people have been protected from this terrifying disease,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We are working in exceptionally challenging circumstances, but thanks to support from donors and the efforts of the Ministry of Health, WHO and partners, we have saved thousands of lives.”

WHO has more than 700 people in DRC and is working hard with partners to listen to the affected communities and address their concerns and give them greater ownership of the response, particularly in the current outbreak hotspots of Katwa and Butembo.

“The communities affected by this outbreak are already traumatized by conflict,” said Dr Tedros. ”Their fear of violence is now compounded by fear of Ebola. Community engagement takes time. There are no quick fixes. But we are learning and adapting to the evolving context every day.”

Despite the challenges, most communities accept response interventions. More than 90% of those eligible for vaccination accept it and agree to post-vaccination follow-up visits. Independent analysis of vaccination data indicate that the vaccine is protecting at least 95% of those who receive it in a timely manner. More than 80% of people also accept safe and dignified burials, a key to preventing onward transmission.

“Despite the increased frequency of attacks by armed groups, WHO will stay the course and will work with communities to end this outbreak together with the Ministry of Health and partners,” said Dr Tedros. “We need redoubled support from the international community, and a commitment to push together to bring this outbreak to an end.”

For the next 6 months, the combined financial need for all response partners is at least $148 million. As of 19 March, $US 74 million had been received.

“We count on donors to help close the funding gap so we can end this outbreak as soon as possible,” said Dr Tedros. “We will still be in DRC long after this outbreak has finished, working with the government and communities on the road to universal health coverage. We are committed to improving the health of the people of DRC now and in years to come.”

24 March 2019 – Goma, DR Congo. The deadly Ebola outbreak in the Democratic Republic of Congo, declared on 1 August 2018, has reached 1,000 cases. This is the second worst outbreak of Ebola in recorded history, after the 2014 outbreak in West Africa, which killed 11,000 people.

“Sadly, DR Congo’s Ebola outbreak, which started in Nord Kivu and has spread to Ituri Province, has marked 1,000 confirmed cases, making it the most disastrous Ebola outbreak in the country’s history,” says Thomas Simon, Country Director at Medair, an international NGO that has worked in DR Congo for 22 years. “If transmission of the disease does not end soon, it could spark the collapse of an already very fragile health system.”

Despite seven months of actively responding, and ongoing vaccination, the efforts of the Ministry of Health, NGOs, and health partners alike are being hampered by violence, mass displacement due to conflicts, community misinformation, and fear. "The virus, which is transmitted through bodily fluids once a person starts to have symptoms, is often mistaken for malaria or cholera because of similar symptoms, causing people not to worry until it is often too late,” says Thomas. "Also, many people believe that if they are taken to an Ebola Centre they will never come out. The fact is that the centres are the only available source of help and possible healing from the disease and the survival rate of people being admitted is higher than the West Africa Ebola outbreak. We have new medications, which can help to treat the disease, but the patients need to come in early and start the treatment,” he adds.

Everyone who comes into contact with a person infected with the virus must be monitored in case they develop symptoms; on average, this represents 100 people. By doing Ebola prevention work alongside community leaders and engagement teams, Medair is ensuring that a dialogue is established and that the messages regarding screening, vaccination, and proper handwashing are clear and culturally accepted.Butembo and Katwa health zones, in Nord Kivu Province, are now the primary areas of concern. Medair is responding to the outbreak in multiple affected areas, including with a transit centre in Oicha, where humanitarian access remains a challenge. “Our teams are working tirelessly to help put an end to the spread of Ebola. Among our activities, we are equipping health facilities and communities with proper water and sanitation structures and training in hygiene practices, essential steps in making sure Ebola does not spread,” reports James Ray, Medair’s Water, Sanitation and Hygiene Advisor.

The latest resilience news from around the worldCurrent Ebola outbreak in DRC now the second largest global outbreak on record

Published: Monday, 25 March 2019 09:01

As of March 24, 2019, public health officials have documented that the Ebola outbreak in eastern Democratic Republic of Congo (DRC) has surpassed 1,000 cases; the current total number of confirmed and probable cases is 1009, including 625 deaths and 318 survivors. The outbreak is the largest in DRC’s history and the second largest outbreak recorded of Ebola ever (after the 2014-2016 outbreak in West Africa).

“This is a disappointing milestone. This remains a highly complex Ebola outbreak with active Ebola transmission in 21 health zones,” said US CDC Director Robert R. Redfield, M.D.

The outbreak in DRC is occurring in a region where there is armed conflict, outbreaks of violence, and other problems that complicate public health response activities and increase the risk of disease spread.

The World Health Organization (WHO) says that the risk of national and regional spread remains very high.

I see that 7 out of the eleven responses to the poll were too optimistic.

I can't remember if I was one of those. My post talks of 'regional' so I could have voted either for the second or the third option. Having armed groups disrupting containment efforts is making it hard to predict what will happen, as the previous experience of quick control in the Congo is not a good model for the current outbreak.

The World Health Organization says the spread of Ebola in the Democratic Republic of Congo is not yet a global health emergency.

The Ebola outbreak is the second biggest in history - infecting 1,206 people and killing 764. It shows no sign of being contained soon.

Efforts by healthcare workers have been hampered by conflict and rebel attacks.

And experts have warned it will be "very difficult to bring it under control".

But Prof Robert Steffen, chairman of the WHO's emergency committee on Ebola, said declaring an emergency would not change anything on the ground.

He said: "It does not mean we can lean back and relax.

"Funds are now needed to avoid a public health emergency of international concern."

The World Health Organization said it had received only half the money it needed to tackle the disease.

The outbreak started in August 2018 and is still contained within two provinces in DRC - North Kivu and Ituri.

However, the WHO has warned a "rising number of security incidents" has been making it hard to monitor the spread of the virus, vaccinate people and contact anyone who has been in contact with an Ebola patient.

Cases have been increasing in recent weeks and the WHO says the risk of the virus spreading to neighbouring countries is "very high".

It says the risk of the virus spreading globally is low.What is Ebola?

It progresses to vomiting, diarrhoea and both internal and external bleeding.

People are infected when they have direct contact through broken skin, or the mouth and nose, with the blood, vomit, faeces or bodily fluids of someone with Ebola.

Patients tend to die from dehydration and multiple organ failure.

Most Ebola outbreaks are over quickly and affect small numbers of people.

Only once before has there been an outbreak that was still expanding - and with such a high number of cases - more than eight months after it began.

That was the epidemic in West Africa between 2013 and 2016 which killed 11,310 people.

Dr Jeremy Farrar, director of the Wellcome charity, said: "The teams in DRC need all our support and resources, including finance, healthcare workers, enhanced security and infrastructure, as well as more international political support.

"This epidemic is at a very dangerous phase in an incredibly difficult environment, and we urgently need the response to evolve to help stop Ebola spreading and save lives."

Unlike the West Africa outbreak, a vaccine has been available which is being used to protect people at risk - including doctors and people who come into contact with an Ebola patient.

However, there have still been 85 cases and 30 deaths among healthcare workers, which further reduces the ability to deal with the outbreak.

There is also a trial of experimental drugs taking place in Ebola centres in the country.

A "public health emergency of international concern" was declared for the Ebola outbreak in West Africa and the Zika virus outbreak in 2016.

Dr Rebecca Katz, the director of the Center for Global Health Science and Security at Georgetown University, said the decision not to declare an emergency was disappointing.

She said: "This is a deeply concerning event, due to the pathogen itself, the total number of cases, the increase in cases just this week, and the difficulty of co-ordinating the response due to conflict - that needs to receive the appropriate level of attention."

Allthough I am not on top of this subject I can see the reasons for being disapointed in not declaring the Congo-ebola outbreak as an international health risk ( or "public health emergency of international concern").

The main problem is lack of money. But behind that there is a total lack of political will, knowledge and care by those who can make a difference.

Both the "west" and Russia, China, Arab states do not seem to care about African lives. As long as those countries do not have to take care of millions of refugees it is okay for them-proberbly that cynical.

With that as a background ebola will most likely find a second large outbreak region-I would not be surprised if that would turn out to be a major city (https://en.wikipedia.org/wiki/Kinshasa 11 million inhabitants) but another area-inside the DRC or its neighbours-could fall victim as well.

Each of the country’s previous nine outbreaks since 1976, when the virus was first identified, occurred in remote regions and were controlled within three months. This time, thousands of health professionals have been deployed and more than 170,000 people have received an effective trial vaccine. Yet May, the tenth month, was the deadliest so far, and a further 349 cases were confirmed in July. - The problem, according to the health ministry, is that up to 40 per cent of Ebola victims ignore official advice to visit such centres, and instead die at home and infect others.

“Community deaths are the worst scenario, and make it very difficult to control the epidemic,” said Gaston Tshapenda, the ministry’s senior official in Beni. “We need to break this vicious circle and establish trust with the community.”-(DJ-Basicly the people do not trust the healthcare workers. So no control-missing 40% is an estimate. )

DJ-A second vaccine is supposed to help, also better relations, trust, is being worked on.

"Her father was a miner in his 40s who was returning from a part of northeastern Ituri province where no Ebola cases in this outbreak have been recorded, WHO officials told reporters." and "His case was not thought to be linked to the earlier death of a pastor who became infected during a visit to the town of Butembo, one of the epicentres of the epidemic. " May give an indication of "loss of controll" in the DRC-Ebola tragedy.

DJ-In my opinion july 2020 ebola will have reached over 10.000 cases and most likely spread even more wider. The only way to stop that is much more effort by international groups to deal with this crisis.

Flooding, hurricanes etc may worsen the situation even further. Massive panic and break down of government could be a nightmare scenario.

We cannot solve our problems with the same thinking we used when we created them.~Albert Einstein

“The gold miner ... will have contaminated several people, but for the moment it is only his wife and one of his ten children who are sick,” Muyembe said.

The man himself had died of the virus earlier this week and only sought treatment more than a week after starting to show symptoms.

“The individual concerned spent time with his family ... (being) very symptomatic within the community. So we did expect further cases and we are seeing further cases,” Margaret Harris, a spokeswoman for the World Health Organisation (WHO), which declared Ebola an international health emergency last month, told journalists in Geneva.

A sister of that same miner who had traveled to Congo’s South Kivu province was swiftly identified and brought back to Goma, Muyembe said.

DJ-Only if we are very lucky Ebola is under control in Goma.

We cannot solve our problems with the same thinking we used when we created them.~Albert Einstein

No new confirmed cases have been reported in Goma city since our last report, with a total of four confirmed cases reported from Goma (n=1) and Nyiragongo (n=3) health zones to date. Of the four cases, two have died and two are in an Ebola Treatment Centre(ETC). On 3 August, all 256 contacts related to the first confirmed case in Goma Health Zone (reported 14 July), finished their 21-day follow up period. A total of 232 contacts (including 114 high risk contacts) of the Nyiragongo cases remain under surveillance. Ongoing vaccination activities have reached the majority (98%) of eligible contacts, and 1314 contacts, contacts of contacts and frontline workers vaccinated to date.

New infections continue to be reported among personnel working in community health posts and other facilities. In the last 21 days, 14 new cases were reported among health workers from Mandima (n=5), Beni (n=4), and one each in Katwa, Mambasa, Masereka, Oicha, and Vuhovi. Cumulatively, 149 (5%) healthcare workers have been infected to date.

We cannot solve our problems with the same thinking we used when we created them.~Albert Einstein

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